Exams and Tests

What exams or tests may be used to detect an aortic aneurysm? The U.S. Public Health Service recommends a one-time screening exam of the belly, an abdominal ultrasound, in some patients. These include men older than 65 or women older than 75 who have a history of smoking.

However, there is no recommendation to test for thoracic aortic aneurysm for the general population. If you have first-degree relatives (mother, brother, father, sister or child) with a history of aneurysm, you should talk to your doctor about whether you need a screening.

If you have symptoms, such as severe chest or abdominal discomfort (see Section 1: Overview), you should seek immediate medical attention. Your health care professional likely will do some basic tests including:

• Blood pressure evaluation
• Listening to your heart
• Chest X-ray
• Electrocardiogram (ECG)

These tests are almost always done but are not enough to fully identify an aortic aneurysm or dissection (tear).

The most common emergency test for aortic aneurysm involves a computed tomography (CT) scan of the chest, and possibly abdomen and pelvis, depending on the case. A CT scan is considered a very safe procedure and generally involves only a small amount of X-ray radiation exposure. Also, an imaging contrast agent is given to the patient through a vein.

Another test may include a transthoracic echocardiogram (TTE), which is an ultrasound placed on the chest to view the heart, similar to an ultrasound of a baby. A TTE can identify an aneurysm in the abdominal aorta and the beginning of the thoracic aorta. However, it may not be able to see important sections of the aortic arch and further along the thoracic aorta.

A TTE is more limited than a CT scan. However, a TTE can detect complications related to an aneurysm dissection, including problems with heart valves, fluid around the heart, or a heart attack from a tear of important blood vessels or loss of blood.

Another test you may have is a transesophageal echocardiogram (TEE). This test can evaluate the entire aorta as effectively as a CT scan. A TTE may, however, miss certain sections of the aorta. This test also requires the patient to be sedated and may cause a patient's blood pressure to drop lower, which is not desirable. However, a TEE may be useful for certain patients, including those who are on a breathing machine or in the intensive care unit.

Finally, a magnetic resonance imaging (MRI) scan may be performed. For patients with long-term, stable aneurysm, an MRI may be useful. However, MRI is not commonly used for emergency cases.